Lavage and/or infusion using csa compounds for increasing fertility in a mammal

ABSTRACT

Increasing fertility in a mammal utilizes cationic steroidal antimicrobial (CSA) compounds and CSA-containing compositions. Such treatment in a mammal includes administering a formulation (e.g., lavage and/or infusion) including at least one CSA compound, or pharmaceutically acceptable salt thereof, to the reproductive structure(s) of the mammal (e.g., horse, dairy cow, human, etc.). The formulation may be applied topically as lavage and/or infusion to desired reproductive structures, such as the vagina, cervix, uterus, penis, or combinations thereof. The formulation may kill both planktonic and biofilm forms of sperm killing microbes, and may at least partially break up a microbial plaque or film located within any of the reproductive structures (e.g., the uterus). The CSA or pharmaceutically acceptable salt thereof may be selective or preferential in its action, so as to preferentially kill sperm killing microbes without causing harm to beneficial microbes also residing within the reproductive structure of the mammal.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No. 61/952,682 filed Mar. 13, 2014, the disclosure of which is incorporated herein in its entirety.

BACKGROUND OF THE INVENTION

1. The Field of the Invention

The present invention relates to compositions and methods for increasing fertility in a mammal using cationic steroidal antimicrobial (CSA) compounds.

2. The Relevant Technology

Maintaining fertility in dairy cows, horses, domestic animals, and other mammals continues to be of importance to those engaged in the farming industry. Loss of fertility greatly reduces the value of breeding animals, which can only then be used for meat but which may not be suitable for such use. Thus, fertility loss, especially premature infertility, may substantially or completely destroy the economic value of an animal relied upon for breeding.

In general, there may be many reasons to restore or enhance fertility in a wide variety of different mammals, including humans. Current treatments to enhance fertility include administration of fertility drugs, including hormones or other substances that act by accelerating ovulation, and/or surgical procedures, some of which can be very invasive and expensive.

In addition to old age, infertility may also be caused by fungal or bacterial endometritis, which occurs when a bacteria or fungus (e.g., yeast) contaminates the uterus and causes infection and inflammation. In some cases, endometritis can be sexually transmitted, such as Contagious Equine Metritis (CEM), caused by Taylorella equigenitalis, a Gram negative coccobacillus. The bacteria can survive for an extended period on the external genitalia of the stallion and the vagina or clitoris of the mare. When infected, the stallion may show no clinical signs. The mare, however, typically presents acute endometritis with a thick, grey, mucoid discharge after breeding and may short cycle due to inflammation. The acute signs may subside rapidly, with some mares remaining as asymptomatic carriers.

Endometritis is difficult to treat and has a high rate of recurrence. Current treatments may include uterine lavage with large volumes of fluid and/or administration of dimethylsulfoxide (DMSO), antifungal agents (e.g., clotrimazole, amphotericin, fluconazole, nystatin), or antibiotics. Such treatments are expensive and outcomes uncertain. The prognosis is often poor since treatment only affects certain stages of bacterial or fungal development. In some cases, the microbe may be attached within folds of the endometrium, or the mare may have delayed uterine clearance. Even with successful treatment, chance of re-infection is high.

Accordingly, there remains a present but unsatisfied need to find reliable treatments for increasing fertility in mammals.

SUMMARY

Disclosed herein are compositions and methods for enhancing fertility in a mammal. According some embodiments, one or more CSA compounds are administered to the reproductive structure (e.g., uterus or penis) of a mammal in order to increase fertility, such as in the form of a lavage and/or infusion. The present methods and use of the compositions disclosed herein have surprisingly been shown to allow previously infertile mammals to conceive, including mammals which did not respond to and become fertile using conventional lavage or other fertility treatments.

For reasons that may not be entirely understood, administering CSA-containing compositions to the uterus or other reproductive structure of a female mammal in the form of a lavage and/or infusion have unexpectedly been found to increase fertility and cause conception in a mammal that was previously unable to conceive. It is also believed that topical application of CSA-containing compositions to the penis of a male mammal prior to copulation may also enhance fertility of the recipient female mammal. According to one theory, the CSA-containing compositions treat infertility by breaking up microbial plaque or film located in a uterus (e.g., metritis or endometritis). It is believed that the CSA-containing composition hastens uterine epithelial cell healing (due to its epitheliotrophic activity) and modulates the inflammation (due to enhanced innate immune response).

For example, infertility may be caused by fungal or bacterial endometritis, which occurs when a bacteria, fungus (e.g., yeast), etc. contaminates the uterus and causes infection and inflammation. This problem is difficult to treat, and has a high rate of recurrence. Current treatments may include uterine lavage with large volumes of fluid or administration of dimethylsulfoxide (DMSO), antifungal agents (e.g., clotrimazole, amphotericin, fluconazole, nystatin), or antibiotics. Such treatments are expensive and outcomes uncertain as the prognosis is often poor since treatment only affects certain stages of bacterial or fungal development and/or the organism may be attached within folds of the endometrium, or the mare may have delayed uterine clearance. Even with successful treatment, chance of re-infection is high. The present methods and use of the compositions disclosed herein have surprisingly been shown to allow mammals to conceive, where the mammals were previously infertile and/or did not positively respond to conventional fertility treatments.

As part of the treatment process, CSA-containing compositions may be formulated to to increase efficacy and/or reduce cytotoxicity to mammals. In some embodiments, the CSA-containing compositions can be formulated in order to deliver CSA compounds as individually dispersed CSA molecules and/or very small CSA particles having low agglomeration. In one embodiment, CSA-containing compositions are formulated in order to remain stable and resist agglomeration of CSA molecules or particles to larger CSA particles over a specified time period. This may be accomplished, for example, by the use of micelle-forming agents which are able to form micelles in a liquid carrier, which encapsulate the CSA molecules and prevent or reduce agglomeration.

Additional features and advantages will be set forth in part in the description that follows, and in part will be obvious from the description, or may be learned by practice of the embodiments disclosed herein. The objects and advantages of the embodiments disclosed herein will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims. It is to be understood that both the foregoing brief summary and the following detailed description are exemplary and explanatory only and are not restrictive of the embodiments disclosed herein or as claimed.

DETAILED DESCRIPTION

Disclosed herein are methods and systems for applying CSA-containing compositions to the genitalia or other reproductive structure of a mammal to enhance fertility. According to some embodiments, a CSA-containing composition is administered to the uterus or other reproductive structure of a female mammal in order to increase fertility, such as in the form of a lavage and/or infusion. According to other embodiments, a CSA-containing composition is applied to the penis of a male mammal prior to copulation with a female mammal. In some embodiments, the CSA-containing compositions may be formulated to control or reduce CSA agglomeration, increase stability, enhance efficacy, and/or reduce cytotoxicity to mammalian cells.

For reasons that may not be entirely understood, administering a CSA-containing composition to the uterus or other reproductive structure of a mammal has unexpectedly been found to increase fertility and cause conception in a mammal that was previously unable to conceive. It is also believed that topical application of a CSA-containing composition to the penis of a male mammal prior to copulation may also enhance fertility of the recipient female mammal.

According to one theory, CSA-containing compositions act by breaking up biofilms and/or killing microbes that form biofilms present in the uterus or other reproductive structure of a mammal that might inhibit fertilization. Such biofilms may form a barrier between gametes (i.e., sperm cells and the ovum) and/or prevent implantation of a fertilized zygote within the uterus and/or cause spontaneous abortion of a zygote shortly after implantation. It is believed that CSA-containing compositions are able to break up biofilms and/or kill microbes that form such biofilms as a result of the unique amphiphilic nature and chemical functionalities of CSA compounds. The CSA-containing composition can also accelerate uterine epithelial cell healing due to its epitheliotrophic activity and modulates the inflammation due to enhanced innate immune response.

As part of the treatment process, CSA-containing compositions may be formulated to to increase efficacy and/or reduce cytotoxicity to mammals. In some embodiments, the CSA-containing compositions can be formulated to deliver CSA compounds as individually dispersed CSA molecules and/or very small CSA particles having low agglomeration. In one embodiment, CSA-containing compositions are formulated in order to remain stable and resist agglomeration of CSA molecules or CSA particles to larger CSA particles over a predetermined time period. This may be accomplished, for example, by the use of micelle-forming agents that are able to form micelles in a liquid carrier, which encapsulate the CSA molecules and prevent or reduce agglomeration. Additional details regarding compositions and methods for forming stable CSA-containing compositions with reduced agglomeration are disclosed in U.S. Provisional Application No. 61/952,669, filed Mar. 13, 2014, the disclosure of which is incorporated herein in its entirety.

Before describing exemplary compositions and methods for forming CSA compositions for treating infertility, as well as a more detailed description of properties, chemical characteristics, and uses, a general description will be given of non-limiting examples of CSA compounds that can be used in the disclosed CSA compositions and methods.

I. CSA COMPOUNDS AND COMPOSITIONS

Cationic steroidal anti-microbial (CSA) compounds, sometimes referred to as “CSAs” or “ceragenin compounds”, can include synthetically produced, small molecule chemical compounds that include a sterol backbone having various charged groups (e.g., amine and cationic groups) attached to the backbone. The sterol backbone can be used to orient the amine or guanidine groups on one face, or plane, of the sterol backbone. CSA compounds are cationic and amphiphilic, based upon the functional groups attached to the backbone. They are facially amphiphilic with a hydrophobic face and a polycationic face. Without wishing to be bound to a particular theory, the CSA compounds described herein act as anti-microbial agents (e.g., anti-bacterials, antifungals, and anti-virals). It is believed, for example, that the CSA compounds act as anti-microbial agents by binding to the cellular membrane of bacteria and other microbes and inserting into the cell membrane, forming one or more pores, which allows leakage of ions and/or cytoplasmic materials critical to the microbe's survival, leading to the death of the affected microbe. In addition, the CSA compounds described herein may also act to sensitize bacteria to other antibiotics. For example, at concentrations below the corresponding minimum bacteriostatic concentration for the CSA compound(s), the CSA compound(s) may nevertheless cause bacteria to become more susceptible to other antibiotics by increasing membrane permeability. It is postulated that ionically charged groups are responsible for disrupting the bacterial cellular membrane and imparting anti-microbial properties.

A. DEFINITIONS

Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which these embodiments belong. The terminology used in the description herein is for describing particular embodiments only and is not intended to be limiting of the embodiments. As used in the specification and the appended claims, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety.

Terms and phrases used in this application, and variations thereof, especially in the appended claims, unless otherwise expressly stated, should be construed as open ended as opposed to limiting. As examples of the foregoing, the term “including” should be read to mean “including, without limitation,” “including but not limited to,” or the like; the term “comprising” as used herein is synonymous with “including,” “containing,” or “characterized by,” and is inclusive or open-ended and does not exclude additional, unrecited elements or method steps; the term “having” should be interpreted as “having at least”; the term “includes” should be interpreted as “includes but is not limited to”; the term “example” is used to provide exemplary instances of the item in discussion, not an exhaustive or limiting list thereof; and use of terms like “preferably,” “preferred,” “desired,” or “desirable,” and words of similar meaning should not be understood as implying that certain features are critical, essential, or even important to the structure or function of the invention, but instead as merely intended to highlight alternative or additional features that may or may not be utilized in a particular embodiment. In addition, the term “comprising” is to be interpreted synonymously with the phrases “having at least” or “including at least”. When used in the context of a process, the term “comprising” means that the process includes at least the recited steps, but may include additional steps. When used in the context of a compound, composition or device, the term “comprising” means that the compound, composition or device includes at least the recited features or components, but may also include additional features or components. Likewise, a group of items linked with the conjunction “and” should not be read as requiring that each and every one of those items be present in the grouping, but rather should be read as “and/or” unless expressly stated otherwise. Similarly, a group of items linked with the conjunction “or” should not be read as requiring mutual exclusivity among that group, but rather should be read as “and/or” unless expressly stated otherwise.

It is understood that, in any compound described herein having one or more chiral centers, if an absolute stereochemistry is not expressly indicated, then each center may independently be of R-configuration or S-configuration or a mixture thereof. Thus, the compounds provided herein may be enantiomerically pure, enantiomerically enriched, racemic mixture, diastereomerically pure, diastereomerically enriched, or a stereoisomeric mixture. In addition it is understood that, in any compound described herein having one or more double bond(s) generating geometrical isomers that can be defined as E or Z, each double bond may independently be E or Z a mixture thereof.

Likewise, it is understood that, in any compound described, all tautomeric forms are also intended to be included.

It is to be understood that where compounds disclosed herein have unfilled valencies, then the valencies are to be filled with hydrogens or isotopes thereof, e.g., hydrogen-1 (protium) and hydrogen-2 (deuterium).

It is understood that the compounds described herein can be labeled isotopically. Substitution with isotopes such as deuterium may afford certain therapeutic advantages resulting from greater metabolic stability, such as, for example, increased in vivo half-life or reduced dosage requirements. Each chemical element as represented in a compound structure may include any isotope of said element. For example, in a compound structure a hydrogen atom may be explicitly disclosed or understood to be present in the compound. At any position of the compound that a hydrogen atom may be present, the hydrogen atom can be any isotope of hydrogen, including but not limited to hydrogen-1 (protium) and hydrogen-2 (deuterium). Thus, reference herein to a compound encompasses all potential isotopic forms unless the context clearly dictates otherwise.

It is understood that the methods and combinations described herein include crystalline forms (also known as polymorphs, which include the different crystal packing arrangements of the same elemental composition of a compound), amorphous phases, salts, solvates, and hydrates. In some embodiments, the compounds described herein exist in solvated forms with pharmaceutically acceptable solvents such as water, ethanol, or the like. In other embodiments, the compounds described herein exist in unsolvated form. Solvates contain either stoichiometric or non-stoichiometric amounts of a solvent, and may be formed during the process of crystallization with pharmaceutically acceptable solvents such as water, ethanol, or the like. Hydrates are formed when the solvent is water, or alcoholates are formed when the solvent is alcohol. In addition, the compounds provided herein can exist in unsolvated as well as solvated forms. In general, the solvated forms are considered equivalent to the unsolvated forms for the purposes of the compounds and methods provided herein.

Unless otherwise indicated, all numbers expressing quantities of ingredients, reaction conditions, and so forth used in the specification and claims are to be understood as being modified in all instances by the term “about.” Accordingly, unless indicated to the contrary, the numerical parameters set forth in the specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained by the present embodiments. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should be construed in light of the number of significant digits and ordinary rounding approaches.

Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the embodiments are approximations, the numerical values set forth in the specific examples are reported as precisely as possible. Any numerical value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements. Every numerical range given throughout this specification and claims will include every narrower numerical range that falls within such broader numerical range, as if such narrower numerical ranges were all expressly written herein. Where a range of values is provided, it is understood that the upper and lower limit, and each intervening value between the upper and lower limit of the range is encompassed within the embodiments.

As used herein, any “R” group(s) such as, without limitation, R₁, R₂, R₃, R₄, R₅, R₆, R₇, R₈, R₉, R₁₀, R₁₁, R₁₂, R₁₃, R₁₄, R₁₅, R₁₆, R₁₇, and R₁₈ represent substituents that can be attached to the indicated atom. Unless otherwise specified, an R group may be substituted or unsubstituted.

The term “ring” as used herein can be heterocyclic or carbocyclic. The term “saturated” used herein refers to a fused ring having each atom in the fused ring either hydrogenated or substituted such that the valency of each atom is filled. The term “unsaturated” used herein refers to a fused ring where the valency of each atom of the fused ring may not be filled with hydrogen or other substituents. For example, adjacent carbon atoms in the fused ring can be doubly bound to each other. Unsaturation can also include deleting at least one of the following pairs and completing the valence of the ring carbon atoms at these deleted positions with a double bond; such as R₅ and R₉; R₈ and R₁₀; and R₁₃ and R₁₄.

Whenever a group is described as being “substituted” that group may be substituted with one, two, three or more of the indicated substituents, which may be the same or different, each replacing a hydrogen atom. If no substituents are indicated, it is meant that the indicated “substituted” group may be substituted with one or more group(s) individually and independently selected from alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, acylalkyl, alkoxyalkyl, aminoalkyl, amino acid, aryl, heteroaryl, heteroalicyclyl, aralkyl, heteroaralkyl, (heteroalicyclyl)alkyl, hydroxy, protected hydroxyl, alkoxy, aryloxy, acyl, mercapto, alkylthio, arylthio, cyano, halogen (e.g., F, Cl, Br, and I), thiocarbonyl, O-carbamyl, N-carbamyl, O-thiocarbamyl, N-thiocarbamyl, C-amido, N-amido, S-sulfonamido, N-sulfonamido, C-carboxy, protected C-carboxy, O-carboxy, isocyanato, thiocyanato, isothiocyanato, nitro, oxo, silyl, sulfenyl, sulfinyl, sulfonyl, haloalkyl, haloalkoxy, trihalomethanesulfonyl, trihalomethanesulfonamido, an amino, a mono-substituted amino group and a di-substituted amino group, R_(a)O(CH₂)_(m)O—, R_(b)(CH₂)_(n)O—, R_(c)C(O)O(CH₂)_(p)O—, and protected derivatives thereof. The substituent may be attached to the group at more than one attachment point. For example, an aryl group may be substituted with a heteroaryl group at two attachment points to form a fused multicyclic aromatic ring system. Biphenyl and naphthalene are two examples of an aryl group that is substituted with a second aryl group.

As used herein, “C_(a)” or “C_(a) to C_(b)” in which “a” and “b” are integers refer to the number of carbon atoms in an alkyl, alkenyl or alkynyl group, or the number of carbon atoms in the ring of a cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl or heteroalicyclyl group. That is, the alkyl, alkenyl, alkynyl, ring of the cycloalkyl, ring of the cycloalkenyl, ring of the cycloalkynyl, ring of the aryl, ring of the heteroaryl or ring of the heteroalicyclyl can contain from “a” to “b”, inclusive, carbon atoms. Thus, for example, a “C₁ to C₄ alkyl” group refers to all alkyl groups having from 1 to 4 carbons, that is, CH₃—, CH₃CH₂—, CH₃CH₂CH₂—, (CH₃)₂CH—, CH₃CH₂CH₂CH₂—, CH₃CH₂CH(CH₃)— and (CH₃)₃C—. If no “a” and “b” are designated with regard to an alkyl, alkenyl, alkynyl, cycloalkyl cycloalkenyl, cycloalkynyl, aryl, heteroaryl or heteroalicyclyl group, the broadest range described in these definitions is to be assumed.

As used herein, “alkyl” refers to a straight or branched hydrocarbon chain that comprises a fully saturated (no double or triple bonds) hydrocarbon group. The alkyl group may have 1 to 25 carbon atoms (whenever it appears herein, a numerical range such as “1 to 25” refers to each integer in the given range; e.g., “1 to 25 carbon atoms” means that the alkyl group may consist of 1 carbon atom, 2 carbon atoms, 3 carbon atoms, etc., up to and including 25 carbon atoms, although the present definition also covers the occurrence of the term “alkyl” where no numerical range is designated). The alkyl group may also be a medium size alkyl having 1 to 15 carbon atoms. The alkyl group could also be a lower alkyl having 1 to 6 carbon atoms. The alkyl group of the compounds may be designated as “C₄” or “C₁-C₄ alkyl” or similar designations. By way of example only, “C₁-C₄ alkyl” indicates that there are one to four carbon atoms in the alkyl chain, i.e., the alkyl chain is selected from methyl, ethyl, propyl, iso-propyl, n-butyl, iso-butyl, sec-butyl, and t-butyl. Typical alkyl groups include, but are in no way limited to, methyl, ethyl, propyl, isopropyl, butyl, isobutyl, tertiary butyl, pentyl and hexyl. The alkyl group may be substituted or unsubstituted.

As used herein, “alkenyl” refers to an alkyl group that contains in the straight or branched hydrocarbon chain one or more double bonds. The alkenyl group may have 2 to 25 carbon atoms (whenever it appears herein, a numerical range such as “2 to 25” refers to each integer in the given range; e.g., “2 to 25 carbon atoms” means that the alkenyl group may consist of 2 carbon atom, 3 carbon atoms, 4 carbon atoms, etc., up to and including 25 carbon atoms, although the present definition also covers the occurrence of the term “alkenyl” where no numerical range is designated). The alkenyl group may also be a medium size alkenyl having 2 to 15 carbon atoms. The alkenyl group could also be a lower alkenyl having 1 to 6 carbon atoms. The alkenyl group of the compounds may be designated as “C₄” or “C₂-C₄ alkyl” or similar designations. An alkenyl group may be unsubstituted or substituted.

As used herein, “alkynyl” refers to an alkyl group that contains in the straight or branched hydrocarbon chain one or more triple bonds. The alkynyl group may have 2 to 25 carbon atoms (whenever it appears herein, a numerical range such as “2 to 25” refers to each integer in the given range; e.g., “2 to 25 carbon atoms” means that the alkynyl group may consist of 2 carbon atom, 3 carbon atoms, 4 carbon atoms, etc., up to and including 25 carbon atoms, although the present definition also covers the occurrence of the term “alkynyl” where no numerical range is designated). The alkynyl group may also be a medium size alkynyl having 2 to 15 carbon atoms. The alkynyl group could also be a lower alkynyl having 2 to 6 carbon atoms. The alkynyl group of the compounds may be designated as “C₄” or “C₂-C₄ alkyl” or similar designations. An alkynyl group may be unsubstituted or substituted.

As used herein, “aryl” refers to a carbocyclic (all carbon) monocyclic or multicyclic aromatic ring system (including fused ring systems where two carbocyclic rings share a chemical bond) that has a fully delocalized pi-electron system throughout all the rings. The number of carbon atoms in an aryl group can vary. For example, the aryl group can be a C₆-C₁₄ aryl group, a C₆-C₁₀ aryl group, or a C₆ aryl group (although the definition of C₆-C₁₀ aryl covers the occurrence of “aryl” when no numerical range is designated). Examples of aryl groups include, but are not limited to, benzene, naphthalene and azulene. An aryl group may be substituted or unsubstituted.

As used herein, “aralkyl” and “aryl(alkyl)” refer to an aryl group connected, as a substituent, via a lower alkylene group. The aralkyl group may have 6 to 20 carbon atoms (whenever it appears herein, a numerical range such as “6 to 20” refers to each integer in the given range; e.g., “6 to 20 carbon atoms” means that the aralkyl group may consist of 6 carbon atom, 7 carbon atoms, 8 carbon atoms, etc., up to and including 20 carbon atoms, although the present definition also covers the occurrence of the term “aralkyl” where no numerical range is designated). The lower alkylene and aryl group of an aralkyl may be substituted or unsubstituted. Examples include but are not limited to benzyl, 2-phenylalkyl, 3-phenylalkyl, and naphthylalkyl.

“Lower alkylene groups” refer to a C₁-C₂₅ straight-chained alkyl tethering groups, such as —CH₂— tethering groups, forming bonds to connect molecular fragments via their terminal carbon atoms. Examples include but are not limited to methylene (—CH₂—), ethylene (—CH₂CH₂—), propylene (—CH₂CH₂CH₂—), and butylene (—CH₂CH₂CH₂CH₂—). A lower alkylene group can be substituted by replacing one or more hydrogen of the lower alkylene group with a substituent(s) listed under the definition of “substituted.”

As used herein, “cycloalkyl” refers to a completely saturated (no double or triple bonds) mono- or multi-cyclic hydrocarbon ring system. When composed of two or more rings, the rings may be joined together in a fused fashion. Cycloalkyl groups can contain 3 to 10 atoms in the ring(s) or 3 to 8 atoms in the ring(s). A cycloalkyl group may be unsubstituted or substituted. Typical cycloalkyl groups include, but are in no way limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl and cyclooctyl.

As used herein, “cycloalkenyl” refers to a mono- or multi-cyclic hydrocarbon ring system that contains one or more double bonds in at least one ring; although, if there is more than one, the double bonds cannot form a fully delocalized pi-electron system throughout all the rings (otherwise the group would be “aryl,” as defined herein). When composed of two or more rings, the rings may be connected together in a fused fashion. A cycloalkenyl group may be unsubstituted or substituted.

As used herein, “cycloalkynyl” refers to a mono- or multi-cyclic hydrocarbon ring system that contains one or more triple bonds in at least one ring. If there is more than one triple bond, the triple bonds cannot form a fully delocalized pi-electron system throughout all the rings. When composed of two or more rings, the rings may be joined together in a fused fashion. A cycloalkynyl group may be unsubstituted or substituted.

As used herein, “alkoxy” or “alkyloxy” refers to the formula —OR wherein R is an alkyl, an alkenyl, an alkynyl, a cycloalkyl, a cycloalkenyl or a cycloalkynyl as defined above. A non-limiting list of alkoxys includes methoxy, ethoxy, n-propoxy, 1-methylethoxy (isopropoxy), n-butoxy, iso-butoxy, sec-butoxy and tert-butoxy. An alkoxy may be substituted or unsubstituted.

As used herein, “acyl” refers to a hydrogen, alkyl, alkenyl, alkynyl, aryl, or heteroaryl connected, as substituents, via a carbonyl group. Examples include formyl, acetyl, propanoyl, benzoyl, and acryl. An acyl may be substituted or unsubstituted.

As used herein, “alkoxyalkyl” or “alkyloxyalkyl” refers to an alkoxy group connected, as a substituent, via a lower alkylene group. Examples include alkyl-O-alkyl- and alkoxy-alkyl- with the terms alkyl and alkoxy defined herein.

As used herein, “hydroxyalkyl” refers to an alkyl group in which one or more of the hydrogen atoms are replaced by a hydroxy group. Exemplary hydroxyalkyl groups include but are not limited to, 2-hydroxyethyl, 3-hydroxypropyl, 2-hydroxypropyl, and 2,2-dihydroxyethyl. A hydroxyalkyl may be substituted or unsubstituted.

As used herein, “haloalkyl” refers to an alkyl group in which one or more of the hydrogen atoms are replaced by a halogen (e.g., mono-haloalkyl, di-haloalkyl and tri-haloalkyl). Such groups include but are not limited to, chloromethyl, fluoromethyl, difluoromethyl, trifluoromethyl and 1-chloro-2-fluoromethyl, 2-fluoroisobutyl. A haloalkyl may be substituted or unsubstituted.

The term “amino” as used herein refers to a —NH₂ group.

As used herein, the term “hydroxy” refers to a —OH group.

A “cyano” group refers to a “CN” group.

A “carbonyl” or an “oxo” group refers to a C═O group.

The term “azido” as used herein refers to a —N₃ group.

As used herein, “aminoalkyl” refers to an amino group connected, as a substituent, via a lower alkylene group. Examples include H₂N-alkyl- with the term alkyl defined herein.

As used herein, “alkylcarboxyalkyl” refers to an alkyl group connected, as a substituent, to a carboxy group that is connected, as a substituent, to an alkyl group. Examples include alkyl-C(═O)O-alkyl- and alkyl-O—C(═O)-alkyl- with the term alkyl as defined herein.

As used herein, “C-carboxyalkyl” refers to a carboxy group connected, as a substituent, to an alkyl group. Examples include HO—(C═O)-alkyl, with the term alkyl as defined herein.

As used herein, “alkylaminoalkyl” refers to an alkyl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group. Examples include alkyl-NH-alkyl-, with the term alkyl as defined herein.

As used herein, “dialkylaminoalkyl” or “di(alkyl)aminoalkyl” refers to two alkyl groups connected, each as a substituent, to an amino group that is connected, as a substituent, to an alkyl group. Examples include

with the term alkyl as defined herein.

As used herein, “alkylaminoalkylamino” refers to an alkyl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group that is connected, as a substituent, to an amino group. Examples include alkyl-NH-alkyl-NH—, with the term alkyl as defined herein.

As used herein, “alkylaminoalkylaminoalkylamino” refers to an alkyl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group that is connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group. Examples include alkyl-NH-alkyl-NH-alkyl-, with the term alkyl as defined herein.

As used herein, “arylaminoalkyl” refers to an aryl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group. Examples include aryl-NH-alkyl-, with the terms aryl and alkyl as defined herein.

As used herein, “aminoalkyloxy” refers to an amino group connected, as a substituent, to an alkyloxy group. Examples include H₂N-alkyl-O— and H₂N-alkoxy- with the terms alkyl and alkoxy as defined herein.

As used herein, “aminoalkyloxyalkyl” refers to an amino group connected, as a substituent, to an alkyloxy group connected, as a substituent, to an alkyl group. Examples include H₂N-alkyl-O-alkyl- and H₂N-alkoxy-alkyl- with the terms alkyl and alkoxy as defined herein.

As used herein, “aminoalkylcarboxy” refers to an amino group connected, as a substituent, to an alkyl group connected, as a substituent, to a carboxy group. Examples include H₂N-alkyl-C(═O)O— and H₂N-alkyl-O—C(═O)— with the term alkyl as defined herein.

As used herein, “aminoalkylaminocarbonyl” refers to an amino group connected, as a substituent, to an alkyl group connected, as a substituent, to an amino group connected, as a substituent, to a carbonyl group. Examples include H₂N-alkyl-NH—C(═O)— with the term alkyl as defined herein.

As used herein, “aminoalkylcarboxamido” refers to an amino group connected, as a substituent, to an alkyl group connected, as a substituent, to a carbonyl group connected, as a substituent to an amino group. Examples include H₂N-alkyl-C(═O)—NH— with the term alkyl as defined herein.

As used herein, “azidoalkyloxy” refers to an azido group connected as a substituent, to an alkyloxy group. Examples include N₃-alkyl-O— and N₃-alkoxy- with the terms alkyl and alkoxy as defined herein.

As used herein, “cyanoalkyloxy” refers to a cyano group connected as a substituent, to an alkyloxy group. Examples include NC-alkyl-O— and NC-alkoxy- with the terms alkyl and alkoxy as defined herein.

As used herein, “guanidinoalkyloxy” refers to a guanidinyl group connected, as a substituent, to an alkyloxy group. Examples include

with the terms “alkyl” and “alkoxy” as defined herein.

As used herein, “guanidinoalkylcarboxy” refers to a guanidinyl group connected, as a substituent, to an alkyl group connected, as a substituent, to a carboxy group. Examples include

with the term “alkyl” as defined herein.

As used herein, “quaternary ammonium alkylcarboxy” refers to a quaternized amino group connected, as a substituent, to an alkyl group connected, as a substituent, to a carboxy group. Examples include

with the term “alkyl” as defined herein.

The term “halogen atom” or “halogen” as used herein, means any one of the radio-stable atoms of column 7 of the Periodic Table of the Elements, such as, fluorine, chlorine, bromine and iodine.

Where the numbers of substituents is not specified (e.g. haloalkyl), there may be one or more substituents present. For example “haloalkyl” may include one or more of the same or different halogens.

As used herein, the term “amino acid” refers to any amino acid (both standard and non-standard amino acids), including, but not limited to, α-amino acids, β-amino acids, γ-amino acids and δ-amino acids. Examples of suitable amino acids include, but are not limited to, alanine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, proline, serine, tyrosine, arginine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. Additional examples of suitable amino acids include, but are not limited to, ornithine, hypusine, 2-aminoisobutyric acid, dehydroalanine, gamma-aminobutyric acid, citrulline, beta-alanine, alpha-ethyl-glycine, alpha-propyl-glycine and norleucine.

A linking group is a divalent moiety used to link one steroid to another steroid. In some embodiments, the linking group is used to link a first CSA compound with a second CSA compound (which may be the same or different). An example of a linking group is (C₁-C₁₀) alkyloxy-(C₁-C₁₀) alkyl.

The terms “P.G.” or “protecting group” or “protecting groups” as used herein refer to any atom or group of atoms that is added to a molecule in order to prevent existing groups in the molecule from undergoing unwanted chemical reactions. Examples of protecting group moieties are described in T. W. Greene and P. G. M. Wuts, Protective Groups in Organic Synthesis, 3. Ed. John Wiley & Sons, 1999, and in J. F. W. McOmie, Protective Groups in Organic Chemistry Plenum Press, 1973, both of which are hereby incorporated by reference for the limited purpose of disclosing suitable protecting groups. The protecting group moiety may be chosen in such a way, that they are stable to certain reaction conditions and readily removed at a convenient stage using methodology known from the art. A non-limiting list of protecting groups include benzyl; substituted benzyl; alkylcarbonyls and alkoxycarbonyls (e.g., t-butoxycarbonyl (BOC), acetyl, or isobutyryl); arylalkylcarbonyls and arylalkoxycarbonyls (e.g., benzyloxycarbonyl); substituted methyl ether (e.g. methoxymethyl ether); substituted ethyl ether; a substituted benzyl ether; tetrahydropyranyl ether; silyls (e.g., trimethylsilyl, triethylsilyl, triisopropylsilyl, t-butyldimethylsilyl, tri-iso-propylsilyloxymethyl, [2-(trimethylsilyl)ethoxy]methyl or t-butyldiphenylsilyl); esters (e.g. benzoate ester); carbonates (e.g. methoxymethyl-carbonate); sulfonates (e.g. tosylate or mesylate); acyclic ketal (e.g. dimethyl acetal); cyclic ketals (e.g., 1,3-dioxane, 1,3-dioxolanes, and those described herein); acyclic acetal; cyclic acetal (e.g., those described herein); acyclic hemiacetal; cyclic hemiacetal; cyclic dithioketals (e.g., 1,3-dithiane or 1,3-dithiolane); orthoesters (e.g., those described herein) and triarylmethyl groups (e.g., trityl; monomethoxytrityl (MMTr); 4,4′-dimethoxytrityl (DMTr); 4,4′,4″-trimethoxytrityl (TMTr); and those described herein). Amino-protecting groups are known to those skilled in the art. In general, the species of protecting group is not critical, provided that it is stable to the conditions of any subsequent reaction(s) on other positions of the compound and can be removed at the appropriate point without adversely affecting the remainder of the molecule. In addition, a protecting group may be substituted for another after substantive synthetic transformations are complete. Clearly, where a CSA compound differs from a compound disclosed herein only in that one or more protecting groups of the disclosed compound has been substituted with a different protecting group, that compound is within the disclosure

CSA compounds may also include a tether or “tail moiety” attached to the sterol backbone. The tail moiety may have variable chain length or size and may be one of charged, uncharged, polar, non-polar, hydrophobic, amphipathic, and the like. In various embodiments, a tail moiety may be attached at R₁₇. A tail moiety may include the heteroatom (O or N) covalently coupled to the sterol backbone. The tail moiety may, for example, be configured to alter the hydrophobicity/hydrophilicity of the CSA compound. CSA compounds of the present disclosure having different degrees of hydrophobicity/hydrophilicity may, for example, have different rates of uptake into different target microbes. Likewise, altering the hydrophobicity/hydrophilicity of the CSA compounds described herein may affect the retention of the CSA compounds in certain media.

B. CSA COMPOUNDS

CSA Compounds useful in accordance with this disclosure are described herein, both generically and with particularity, and in U.S. Pat. Nos. 6,350,738, 6,486,148, 6,767,904, 7,598,234, 7,754,705, U.S. Application Ser. Nos. 61/786,301, 13/288,892, 61/642,431, 13/554,930, 61/572,714, 13/594,608, 61/576,903, 13/594,612, 13/288,902, 61/605,639, 13/783,131, 61/605,642, 13/783,007, 61/132,361, 13/000,010, 61/534,185, 13/615,244, 61/534,194, 13/615,324, 61/534,205, 61/637,402, 13/841,549, 61/715,277, PCT/US13/37615, 61/749,800, 61/794,721, and 61/814,816, which are incorporated herein by reference. Additional compounds are generally and specifically described in relation to the methods discussed herein. The skilled artisan will recognize the compounds within the generic formulae set forth herein and understand their preparation in view of the references cited herein and the Examples.

In some embodiments, the CSA compound is a compound of Formula (I) or a pharmaceutically acceptable salt thereof:

wherein:

rings A, B, C, and D are independently saturated, or are fully or partially unsaturated, provided that at least two of rings A, B, C, and D are saturated;

m, n, p, and q are independently 0 or 1;

R₁ through R₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, and R₁₈ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted alkyl, a substituted or unsubstituted hydroxyalkyl, a substituted or unsubstituted alkyloxyalkyl, a substituted or unsubstituted alkylcarboxyalkyl, a substituted or unsubstituted alkylaminoalkyl, a substituted or unsubstituted alkylaminoalkylamino, a substituted or unsubstituted alkylaminoalkylaminoalkylamino, a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted arylaminoalkyl, a substituted or unsubstituted haloalkyl, a substituted or unsubstituted alkenyl, a substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted aminoalkyloxyalkyl, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted aminoalkylaminocarbonyl, a substituted or unsubstituted aminoalkylcarboxamido, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)—C(O)—O—, H₂N—HC(Q₅)—C(O)—N(H)—, a substituted or unsubstituted azidoalkyloxy, a substituted or unsubstituted cyanoalkyloxy, P.G.-HN—HC(Q₅)—C(O)—O—, a substituted or unsubstituted guanidinoalkyloxy, a substituted or unsubstituted quaternaryammoniumalkylcarboxy, and a substituted or unsubstituted guanidinoalkyl carboxy, where Q₅ is a side chain of any amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; and

R₅, R₈, R₉, R₁₀, R₁₃, R₁₄ and R₁₇ are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R₅, R₈, R₉, R₁₀, R₁₃, and R₁₄ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted alkyl, a substituted or unsubstituted hydroxyalkyl, a substituted or unsubstituted alkyloxyalkyl, a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted haloalkyl, a substituted or unsubstituted alkenyl, a substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted aminoalkylaminocarbonyl, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)—C(O)—O—, H₂N—HC(Q₅)—C(O)—N(H)—, azidoalkyloxy, cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, guanidinoalkyloxy, and guanidine-alkylcarboxy, where Q₅ is a side chain of any amino acid, P.G. is an amino protecting group,

provided that at least two or three of R₁₋₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, R₁₇, and R₁₈ are independently selected from the group consisting of a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted alkylcarboxyalkyl, a substituted or unsubstituted alkylaminoalkylamino, a substituted or unsubstituted alkylaminoalkylaminoalkylamino, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted arylaminoalkyl, a substituted or unsubstituted aminoalkyloxyaminoalkylaminocarbonyl, a substituted or unsubstituted aminoalkylaminocarbonyl, a substituted or unsubstituted aminoalkylcarboxyamido, a quaternaryammoniumalkylcarboxy, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, azidoalkyloxy, cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted guanidinoalkyloxy, and a substituted or unsubstituted guanidinoalkylcarboxy.

In some embodiments, R₁ through R₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, and R₁₈ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted (C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) hydroxyalkyl, a substituted or unsubstituted (C₁-C₂₂) alkyloxy-(C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) alkylcarboxy-(C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) alkylamino-(C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) alkylamino-(C₁-C₂₂) alkylamino, a substituted or unsubstituted (C₁-C₂₂) alkylamino-(C₁-C₂₂) alkylamino-(C₁-C₂₂) alkylamino, a substituted or unsubstituted (C₁-C₂₂) aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted arylamino-(C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) haloalkyl, a substituted or unsubstituted C₂-C₆ alkenyl, a substituted or unsubstituted C₂-C₆ alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted (C₁-C₂₂) aminoalkyloxy, a substituted or unsubstituted (C₁-C₂₂) aminoalkyloxy-(C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) aminoalkylcarboxy, a substituted or unsubstituted (C₁-C₂₂) aminoalkylaminocarbonyl, a substituted or unsubstituted (C₁-C₂₂) aminoalkylcarboxamido, a substituted or unsubstituted di(C₁-C₂₂ alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, a substituted or unsubstituted (C₁-C₂₂) azidoalkyloxy, a substituted or unsubstituted (C₁-C₂₂) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted (C₁-C₂₂) guanidinoalkyloxy, a substituted or unsubstituted (C₁-C₂₂) quaternaryammoniumalkylcarboxy, and a substituted or unsubstituted (C₁-C₂₂) guanidinoalkyl carboxy, where Q₅ is a side chain of any amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; R₅, R₈, R₉, R₁₀, R₁₃, R₁₄ and R₁₇ are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R₅, R₈, R₉, R₁₀, R₁₃, and R₁₄ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted (C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) hydroxyalkyl, a substituted or unsubstituted (C₁-C₂₂) alkyloxy-(C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted (C₁-C₂₂) haloalkyl, a substituted or unsubstituted (C₂-C₆) alkenyl, a substituted or unsubstituted (C₂-C₆) alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted (C₁-C₂₂) aminoalkyloxy, a substituted or unsubstituted (C₁-C₂₂) aminoalkylcarboxy, a substituted or unsubstituted (C₁-C₂₂) aminoalkylaminocarbonyl, a substituted or unsubstituted di(C₁-C₂₂ alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, a substituted or unsubstituted (C₁-C₂₂) azidoalkyloxy, a substituted or unsubstituted (C₁-C₂₂) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted (C₁-C₂₂) guanidinoalkyloxy, and (C₁-C₂₂) guanidinoalkylcarboxy, where Q5 is a side chain of any amino acid, and P.G. is an amino protecting group; provided that at least two or three of R₁₋₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, R₁₇, and R₁₈ are independently selected from the group consisting of a substituted or unsubstituted (C₁-C₂₂) aminoalkyl, a substituted or unsubstituted (C₁-C₂₂) aminoalkyloxy, a substituted or unsubstituted (C₁-C₂₂) alkylcarboxy-(C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂) alkylamino-(C₁-C₂₂) alkylamino, a substituted or unsubstituted (C₁-C₂₂) alkylamino-(C₁-C₂₂) alkylamino (C₁-C₂₂) alkylamino, a substituted or unsubstituted (C₁-C₂₂) aminoalkylcarboxy, a substituted or unsubstituted arylamino (C₁-C₂₂) alkyl, a substituted or unsubstituted (C₁-C₂₂)aminoalkyloxy (C₁-C₂₂) aminoalkylaminocarbonyl, a substituted or unsubstituted (C₁-C₂₂) aminoalkylaminocarbonyl, a substituted or unsubstituted (C₁-C₂₂) aminoalkylcarboxyamido, a substituted or unsubstituted (C₁-C₂₂) quaternaryammoniumalkylcarboxy, a substituted or unsubstituted di(C₁-C₂₂ alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, a substituted or unsubstituted (C₁-C₂₂) azidoalkyloxy, a substituted or unsubstituted (C₁-C₂₂) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted (C₁-C₂₂) guanidinoalkyloxy, and a substituted or unsubstituted (C₁-C₂₂) guanidinoalkylcarboxy.

In some embodiments, R₁ through R₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, and R₁₈ are independently selected from the group consisting of hydrogen, hydroxyl, an unsubstituted (C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) hydroxyalkyl, unsubstituted (C₁-C₁₈) alkyloxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylcarboxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈)alkyl, unsubstituted (C₁-C₁₈) alkyl amino-(C₁-C₁₈) alkylamino, (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, an unsubstituted (C₁-C₁₈) aminoalkyl, an unsubstituted aryl, an unsubstituted arylamino-(C₁-C₁₈) alkyl, oxo, an unsubstituted (C₁-C₁₈) aminoalkyloxy, an unsubstituted (C₁-C₁₈) aminoalkyloxy-(C₁-C₁₈) alkyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxy, an unsubstituted (C₁-C₁₈) aminoalkylaminocarbonyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxamido, an unsubstituted di(C₁-C₁₈ alkyl)aminoalkyl, unsubstituted (C₁-C₁₈) guanidinoalkyloxy, unsubstituted (C₁-C₁₈) quaternaryammoniumalkylcarboxy, and unsubstituted (C₁-C₁₈) guanidinoalkyl carboxy; R₅, R₈, R₉, R₁₀, R₁₃, R₁₄ and R₁₇ are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R₅, R₈, R₉, R₁₀, R₁₃, and R₁₄ are independently selected from the group consisting of hydrogen, hydroxyl, an unsubstituted (C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) hydroxyalkyl, unsubstituted (C₁-C₁₈) alkyloxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylcarboxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈)alkyl, (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, an unsubstituted (C₁-C₁₈) aminoalkyl, an unsubstituted aryl, an unsubstituted arylamino-(C₁-C₁₈) alkyl, oxo, an unsubstituted (C₁-C₁₈) aminoalkyloxy, an unsubstituted (C₁-C₁₈) aminoalkyloxy-(C₁-C₁₈) alkyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxy, an unsubstituted (C₁-C₁₈) aminoalkylaminocarbonyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxamido, an unsubstituted di(C₁-C₁₈ alkyl)aminoalkyl, unsubstituted (C₁-C₁₈) guanidinoalkyloxy, unsubstituted (C₁-C₁₈) quaternaryammoniumalkylcarboxy, and unsubstituted (C₁-C₁₈) guanidinoalkyl carboxy; provided that at least two or three of R₁₋₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, R₁₇, and R₁₈ are independently selected from the group consisting of of hydrogen, hydroxyl, an unsubstituted (C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) hydroxyalkyl, unsubstituted (C₁-C₁₈) alkyloxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylcarboxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈)alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, an unsubstituted (C₁-C₁₈) aminoalkyl, an unsubstituted aryl, an unsubstituted arylamino-(C₁-C₁₈) alkyl, oxo, an unsubstituted (C₁-C₁₈) aminoalkyloxy, an unsubstituted (C₁-C₁₈) aminoalkyloxy-(C₁-C₁₈) alkyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxy, an unsubstituted (C₁-C₁₈) aminoalkylaminocarbonyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxamido, an unsubstituted di(C₁-C₁₈ alkyl) amino alkyl, unsubstituted (C₁-C₁₈) guanidinoalkyloxy, unsubstituted (C₁-C₁₈) quaternaryammoniumalkylcarboxy, and unsubstituted (C₁-C₁₈) guanidinoalkyl carboxy.

In some embodiments, the CSA compound, or a pharmaceutically acceptable salt thereof, is selected from the compound of Formula (IA), which is a subgenus of Formula (I) in that R₁₅ is omitted:

In some embodiments, rings A, B, C, and D are independently saturated.

In some embodiments, one or more of rings A, B, C, and D are heterocyclic.

In some embodiments, rings A, B, C, and D are non-heterocyclic.

In some embodiments, R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of hydrogen, an unsubstituted (C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) hydroxyalkyl, unsubstituted (C₁-C₁₈) alkyloxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylcarboxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈)alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, an unsubstituted (C₁-C₁₈) aminoalkyl, an unsubstituted arylamino-(C₁-C₁₈) alkyl, an unsubstituted (C₁-C₁₈) aminoalkyloxy, an unsubstituted (C₁-C₁₈) aminoalkyloxy-(C₁-C₁₈) alkyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxy, an unsubstituted (C₁-C₁₈) amino alkyl-aminocarbonyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxamido, an unsubstituted di(C₁-C₁₈ alkyl)aminoalkyl, unsubstituted (C₁-C₁₈) guanidinoalkyloxy, unsubstituted (C₁-C₁₈) quaternaryammoniumalkylcarboxy, and unsubstituted (C₁-C₁₈) guanidinoalkyl carboxy; and R₁, R₂, R₄, R₅, R₆, R₈, R₉, R₁₀, R₁₁, R₁₃, R₁₄, R₁₅, R₁₆, and R₁₇ are independently selected from the group consisting of hydrogen and unsubstituted (C₁-C₆) alkyl.

In some embodiments, R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of hydrogen, an unsubstituted (C₁-C₆) alkyl, unsubstituted (C₁-C₆) hydroxyalkyl, unsubstituted (C₁-C₁₆) alkyloxy-(C₁-C₅) alkyl, unsubstituted (C₁-C₁₆) alkylcarboxy-(C₁-C₅) alkyl, unsubstituted (C₁-C₁₆) alkylamino-(C₁-C₅)alkyl, unsubstituted (C₁-C₁₆) alkylamino-(C₁-C₅) alkylamino, unsubstituted (C₁-C₁₆) alkylamino-(C₁-C₁₆) alkylamino-(C₁-C₅) alkylamino, an unsubstituted (C₁-C₁₆) aminoalkyl, an unsubstituted arylamino-(C₁-C₅) alkyl, an unsubstituted (C₁-C₅) aminoalkyloxy, an unsubstituted (C₁-C₁₆) aminoalkyloxy-(C₁-C₅) alkyl, an unsubstituted (C₁-C₅) aminoalkylcarboxy, an unsubstituted (C₁-C₅) aminoalkylaminocarbonyl, an unsubstituted (C₁-C₅) aminoalkylcarboxamido, an unsubstituted di(C₁-C₅ alkyl)amino-(C₁-C₅) alkyl, unsubstituted (C₁-C₅) guanidinoalkyloxy, unsubstituted (C₁-C₁₆) quaternaryammoniumalkylcarboxy, and unsubstituted (C₁-C₁₆) guanidinoalkylcarboxy.

In some embodiments, R₁, R₂, R₄, R₅, R₆, R₈, R₁₀, R₁₁, R₁₄, R₁₆, and R₁₇ are each hydrogen; and R₉ and R₁₃ are each methyl.

In some embodiments, R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkylcarboxyalkyl; and hydroxyalkyl.

In some embodiments, R₃, R₇, and R₁₂ are independently selected from the group consisting of aminoalkyloxy and aminoalkylcarboxy; and R₁₈ is selected from the group consisting of alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonyloxyalkyl; di(alkyl)aminoalkyl; alkylaminoalkyl; alkyoxycarbonylalkyl; alkylcarboxyalkyl; and hydroxyalkyl.

In some embodiments, R₃, R₇, and R₁₂ are the same. In some embodiments, R₃, R₇, and R₁₂ are aminoalkyloxy. In some embodiments, R₃, R₇, and R₁₂ are aminoalkylcarboxy. In some embodiments, R₁₈ is alkylaminoalkyl. In some embodiments, R₁₈ is alkoxycarbonylalkyl. In some embodiments, R₁₈ is di(alkyl)aminoalkyl. In some embodiments, R₁₈ is alkylcarboxyalkyl. In some embodiments, R₁₈ is hydroxyalkyl.

In some embodiments, R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of amino-C₃-alkyloxy; amino-C₃-alkyl-carboxy; C₈-alkylamino-C₅-alkyl; C₈-alkoxy-carbonyl-C₄-alkyl; C₈-alkyl-carbonyl-C₄-alkyl; di-(C₅-alkyl)amino-C₅-alkyl; C₁₃-alkylamino-C₅-alkyl; C₆-alkoxy-carbonyl-C₄-alkyl; C₆-alkyl-carboxy-C₄-alkyl; and C₁₆-alkylamino-C₅-alkyl.

In some embodiments, at least two, or at least three, of m, n, p, and q are 1. In some embodiments, m, n, and p are each 1 and q is 0.

In some embodiments, the CSA compound, or a pharmaceutically acceptable salt thereof, is selected from the compound of Formula (IB), which is a subgenus of Formula (IA):

In some embodiments, the CSA compound, or a pharmaceutically acceptable salt thereof of the compound of Formula (IB), is selected from the group consisting of:

In some embodiments, the CSA compound, or a pharmaceutically acceptable salt thereof, is selected from the compound of Formula (II), which is related to, but not identical to, Formula (I), e.g., in that R₁₈, rather than R₁₅, is optional and can be omitted:

wherein

rings A, B, C, and D are independently saturated, or are fully or partially unsaturated, provided that at least two of rings A, B, C, and D are saturated;

m, n, p, and q are independently 0 or 1;

each of R₁ through R₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, R₁₇, and R₁₈ is independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted (C₁-C₁₀) alkyl, (C₁-C₁₀) hydroxyalkyl, (C₁-C₁₀) alkyloxy-(C₁-C₁₀) alkyl, (C₁-C₁₀) alkylcarboxy-(C₁-C₁₀) alkyl, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkyl, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, a substituted or unsubstituted (C₁-C₁₀) aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted arylamino-(C₁-C₁₀) alkyl, (C₁-C₁₀) haloalkyl, C₂-C₆ alkenyl, C₂-C₆ alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy-(C₁-C₁₀) alkyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkylcarboxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkylaminocarbonyl, a substituted or unsubstituted (C₁-C₁₀)aminoalkylcarboxamido, H₂N—HC(Q₅)-C(O)—O, H₂N—HC(Q₅)-C(O)—N(H)—, (C₁-C₁₀) azidoalkyloxy, (C₁-C₁₀) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, (C₁-C₁₀) guanidinoalkyloxy, (C₁-C₁₀) quaternary ammonium alkylcarboxy, and (C₁-C₁₀) guanidinoalkyl carboxy, where Q₅ is a side chain of any amino acid (including a side chain of glycine, i.e., H), P.G. is an amino protecting group; and

each of R₅, R₈, R₉, R₁₀, R₁₃, and R₁₄ may be independently deleted when one of fused rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted (C₁-C₁₀) alkyl, (C₁-C₁₀) hydroxyalkyl, (C₁-C₁₀) alkyloxy-(C₁-C_(m)) alkyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkyl, a substituted or unsubstituted aryl, (C₁-C₁₀) haloalkyl, C₂-C₆ alkenyl, C₂-C₆ alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkylcarboxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkylaminocarbonyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, (C₁-C₁₀)azidoalkyloxy, (C₁-C₁₀) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, (C₁-C₁₀) guanidinoalkyloxy, and (C₁-C₁₀) guanidinoalkylcarboxy, where Q₅ is a side chain of any amino acid, P.G. is an amino protecting group, provided that at least two or three of R₁₋₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, R₁₇, and R₁₈ are independently selected from the group consisting of a substituted or unsubstituted (C₁-C₁₀) aminoalkyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy, (C₁-C₁₀) alkylcarboxy-(C₁-C₁₀) alkyl, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, a substituted or unsubstituted (C₁-C₁₀) aminoalkylcarboxy, a substituted or unsubstituted arylamino (C₁-C₁₀) alkyl, a substituted or unsubstituted (C₁-C₁₀)aminoalkyloxy-(C₁-C₁₀) aminoalkylamino-carbonyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkylaminocarbonyl, a substituted or unsubstituted (C₁-C₅) aminoalkylcarboxyamido, a (C₁-C₁₀) quaternary ammonium alkylcarboxy, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, (C₁-C₁₀) azidoalkyloxy, (C₁-C₁₀) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, (C₁-C₁₀) guanidine-alkyloxy, and a (C₁-C₁₀) guanidinoalkylcarboxy.

In Formula (II), at least two or three of R₃, R₇, or R₁₂ may independently include a cationic moiety attached to the Formula (II) structure via a hydrolysable linkage. Optionally, a tail moiety may be attached to Formula (II) at R₁₇. The tail moiety may be charged, uncharged, polar, non-polar, hydrophobic, amphipathic, and the like. Although not required, at least two or three of m, n, p. and q can be 1. In a preferred embodiment, m, n, and p=1 and q=0.

In some embodiments, the compound of Formula (II) or pharmaceutically acceptable salt can be represented by Formula (IIA), which is a subgenus of Formula (II) in that R₁₈ is omitted:

wherein

fused rings A, B, C, and D are independently saturated or fully or partially unsaturated;

each of R₁ through R₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, and R₁₇ is independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted (C₁-C₁₀) alkyl, (C₁-C₁₀) hydroxyalkyl, (C₁-C₁₀) alkyloxy-(C₁-C₁₀) alkyl, (C₁-C₁₀) alkylcarboxy-(C₁-C₁₀) alkyl, C₁-C₁₀) alkylamino-(C₁-C₁₀) alkyl, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, a substituted or unsubstituted (C₁-C₁₀) aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted arylamino-(C₁-C₁₀) alkyl, (C₁-C₁₀)haloalkyl, C₂-C₆ alkenyl, C₂-C₆ alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy-(C₁-C₁₀) alkyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkylcarboxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkylaminocarbonyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkylcarboxamido, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, (C₁-C₁₀) azidoalkyloxy, (C₁-C₁₀) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, (C₁-C₁₀) guanidinoalkyloxy, (C₁-C₁₀) quaternary ammonium alkylcarboxy, and (C₁-C₁₀) guanidinoalkyl carboxy, where Q₅ is a side chain of any amino acid (including the side chain of glycine, i.e., H), PG. is an amino protecting group;

R₅, R₈, R₉, R₁₀, R₁₃, and R₁₄ is each independently: deleted when one of fused rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted (C₁-C₁₀) alkyl, (C₁-C₁₀) hydroxyalkyl, (C₁-C₁₀) alkyloxy-(C₁-C₁₀) alkyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkyl, a substituted or unsubstituted aryl, C₁-C₁₀ haloalkyl, C₂-C₆ alkenyl, C₂-C₆ alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkylcarboxy, a substituted or unsubstituted (C₁-C₁₀) aminoalkylaminocarbonyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, (C₁-C₁₀) azidoalkyloxy, (C₁-C₁₀) cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, (C₁-C₁₀) guanidine-alkyloxy, and (C₁-C₁₀) guanidinoalkylcarboxy, where Q₅ is a side chain of any amino acid, PG. is an amino protecting group; and

at least two of R₁ through R₁₄ are independently selected from the group consisting of a substituted or unsubstituted (C₁-C₁₀) aminoalkyloxy, (C₁-C₁₀) alkylcarboxy(C₁-C₁₀) alkyl, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, (C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino-(C₁-C₁₀) alkylamino, a substituted or unsubstituted (C₁-C₁₀) aminoalkylcarboxy, a substituted or unsubstituted arylamino(C₁-C₁₀) alkyl, a substituted or unsubstituted (C₁-C₁₀) amino alkyloxy-(C₁-C₁₀) alkyl, a substituted or unsubstituted (C₁-C₁₀) aminoalkylaminocarbonyl, (C₁-C₁₀) quaternary ammonium alkylcarboxy, H₂N—HC(Q₅)C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, (C₁-C₁₀) azidoalkyloxy, (C₁-C₁₀) cyanoalkyloxy, PG.-HN—HC(Q₅)-C(O)—O—, (C₁-C₁₀) guanidinoalkyloxy, and (C₁-C₁₀) guanidinoalkylcarboxy.

In some embodiments, compounds comprise a ring system of at least 4 fused rings, where each of the rings has from 5-7 atoms. The ring system has two faces, and contains 3 chains attached to the same face. Each of the chains contains a nitrogen-containing group that is separated from the ring system by at least one atom; the nitrogen-containing group is an amino group, e.g., a primary amino group, or a guanidino group.

C. PHARMACEUTICALLY ACCEPTABLE SALTS

The compounds and compositions disclosed herein are optionally prepared as pharmaceutically acceptable salts. The term “pharmaceutically acceptable salt” as used herein is a broad term, and is to be given its ordinary and customary meaning to a skilled artisan (and is not to be limited to a special or customized meaning), and refers without limitation to a salt of a compound that does not cause significant irritation to an organism to which it is administered and does not abrogate the biological activity and properties of the compound. In some embodiments, the salt is an acid addition salt of the compound. Pharmaceutical salts can be obtained by reacting a compound with inorganic acids such as hydrohalic acid (e.g., hydrochloric acid or hydrobromic acid), sulfuric acid, nitric acid, and phosphoric acid. Pharmaceutical salts can also be obtained by reacting a compound with an organic acid such as aliphatic or aromatic carboxylic or sulfonic acids, for example formic acid, acetic acid, propionic acid, glycolic acid, pyruvic acid, malonic acid, maleic acid, fumaric acid, trifluoroacetic acid, benzoic acid, cinnamic acid, mandelic acid, succinic acid, lactic acid, malic acid, tartaric acid, citric acid, ascorbic acid, nicotinic acid, methanesulfonic acid, ethanesulfonic acid, p-toluensulfonic acid, salicylic acid, stearic acid, muconic acid, butyric acid, phenylacetic acid, phenylbutyric acid, valproic acid, 1,2-ethanedisulfonic acid, 2-hydroxyethanesulfonic acid, benzenesulfonic acid, 2-naphthalenesulfonic acid, or naphthalenesulfonic acid. Pharmaceutical salts can also be obtained by reacting a compound with a base to form a salt such as an ammonium salt, an alkali metal salt, such as a lithium, sodium or a potassium salt, an alkaline earth metal salt, such as a calcium, magnesium or aluminum salt, a salt of organic bases such as dicyclohexylamine, N-methyl-D-glucamine, tris(hydroxymethyl)methylamine, C₁-C₇ alkylamine, cyclohexylamine, dicyclohexylamine, triethanolamine, ethylenediamine, ethanolamine, diethanolamine, triethanolamine, tromethamine, and salts with amino acids such as arginine and lysine; or a salt of an inorganic base, such as aluminum hydroxide, calcium hydroxide, potassium hydroxide, sodium carbonate, sodium hydroxide, or the like.

In some embodiments, the pharmaceutically acceptable salt is a hydrochloride salt. In some embodiments, the pharmaceutically acceptable salt is a mono-hydrochloride salt, a di-hydrochloride salt, a tri-hydrochloride salt, or a tetra-hydrochloride salt. Additional examples of pharmaceutically acceptable salts include sulfuric acid addition salts and sulfonic acid addition salts. 1,5-naphthalenedisulfonic acid is a particularly useful sulfonic acid addition salt.

D. PHARMACEUTICAL COMPOSITIONS

While it is possible for the compounds described herein to be administered alone, it may be desirable to formulate compounds as pharmaceutical compositions. As such, in yet another aspect, pharmaceutical compositions useful in the methods and uses of the disclosed embodiments are provided. More particularly, the pharmaceutical compositions described herein may be useful, inter alia, for treating or preventing infertility in a mammal. A pharmaceutical composition is any composition that may be administered in vitro or in vivo or both to a subject in order to treat or ameliorate a condition. In a preferred embodiment, a pharmaceutical composition may be administered in vivo. A subject may include one or more cells or tissues, or organisms. In some exemplary embodiments, the subject is an animal. In some embodiments, the animal is a mammal. A mammal includes any mammal, such as by way of non-limiting example, cattle, pigs, sheep, goats, horses, camels, buffalo, cats, dogs, rats, mice, humans, and primates.

As used herein the terms “pharmaceutically acceptable” and “physiologically acceptable” mean a biologically compatible formulation, gaseous, liquid or solid, or mixture thereof, which is suitable for one or more routes of administration, in vivo delivery, or contact. A formulation is compatible in that it does not destroy activity of an active ingredient therein (e.g., a CSA compound), or induce adverse side effects that far outweigh any prophylactic or therapeutic effect or benefit.

In an embodiment, the pharmaceutical compositions may be formulated with pharmaceutically acceptable excipients such as carriers, solvents, stabilizers, adjuvants, diluents, etc., depending upon the particular mode of administration and dosage form. The pharmaceutical compositions should generally be formulated to achieve a physiologically compatible pH, and may range from a pH of about 3 to a pH of about 11, preferably about pH 3 to about pH 7, depending on the formulation and route of administration. In alternative embodiments, it may be preferred that the pH is adjusted to a range from about pH 5.0 to about pH 8. More particularly, the pharmaceutical compositions may comprise a therapeutically or prophylactically effective amount of at least one compound as described herein, together with one or more pharmaceutically acceptable excipients. Optionally, the pharmaceutical compositions may comprise a combination of the compounds described herein, or may include a second active ingredient useful in the treatment or prevention of bacterial infection (e.g., anti-bacterial or anti-microbial agents).

Formulations, e.g., for parenteral or oral administration, are most typically solids, liquid solutions, emulsions or suspensions, while inhalable formulations for pulmonary administration are generally liquids or powders. A preferred pharmaceutical composition may also be formulated as a lyophilized solid that is reconstituted with a physiologically compatible solvent prior to administration. Alternative pharmaceutical compositions may be formulated as syrups, creams, ointments, tablets, and the like. Lavages and/or infusions of the CSA compositions may preferably be in the form of a liquid that is introduced into the uterus of the female mammal.

The term “pharmaceutically acceptable excipient” refers to an excipient for administration of a pharmaceutical agent, such as the compounds described herein. The term refers to any pharmaceutical excipient that may be administered without undue toxicity.

Pharmaceutically acceptable excipients are determined in part by the particular composition being administered, as well as by the particular method used to administer the composition. Accordingly, there exists a wide variety of suitable formulations of pharmaceutical compositions (see, e.g., Remington's Pharmaceutical Sciences).

Suitable excipients may be carrier molecules that include large, slowly metabolized macromolecules such as proteins, polysaccharides, polylactic acids, polyglycolic acids, polymeric amino acids, amino acid copolymers, and inactive virus particles. Other exemplary excipients include antioxidants such as ascorbic acid; chelating agents such as EDTA; carbohydrates such as dextrin, hydroxyalkylcellulose, hydroxyalkylmethylcellulose, stearic acid; liquids such as oils, water, saline, glycerol and ethanol; wetting or emulsifying agents; pH buffering substances; and the like. Liposomes are also included within the definition of pharmaceutically acceptable excipients.

The pharmaceutical compositions described herein may be formulated in any form suitable for the intended method of administration. When intended for oral use for example, tablets, troches, lozenges, aqueous or oil suspensions, non-aqueous solutions, dispersible powders or granules (including micronized particles or nanoparticles), emulsions, hard or soft capsules, syrups or elixirs may be prepared. Compositions intended for oral use may be prepared according to any method known to the art for the manufacture of pharmaceutical compositions, and such compositions may contain one or more agents including sweetening agents, flavoring agents, coloring agents and preserving agents, in order to provide a palatable preparation. Pharmaceutical compositions may be formulated as suspensions comprising a compound of the embodiments in admixture with at least one pharmaceutically acceptable excipient suitable for the manufacture of a suspension. In yet another embodiment, pharmaceutical compositions may be formulated as dispersible powders and granules suitable for preparation of a suspension by the addition of suitable excipients.

Excipients suitable for use in connection with suspensions include suspending agents, such as sodium carboxymethylcellulose, methylcellulose, hydroxypropyl methylcellulose, sodium alginate, polyvinylpyrrolidone, gum tragacanth, gum acacia, dispersing or wetting agents such as a naturally occurring phosphatide (e.g., lecithin), a condensation product of an alkylene oxide with a fatty acid (e.g., polyoxyethylene stearate), a condensation product of ethylene oxide with a long chain aliphatic alcohol (e.g., heptadecaethyleneoxycethanol), a condensation product of ethylene oxide with a partial ester derived from a fatty acid and a hexitol anhydride (e.g., polyoxyethylene sorbitan monooleate); polysaccharides and polysaccharide-like compounds (e.g. dextran sulfate); glycoaminoglycans and glycosaminoglycan-like compounds (e.g., hyaluronic acid); and thickening agents, such as carbomer, beeswax, hard paraffin or cetyl alcohol. The suspensions may also contain one or more preservatives such as acetic acid, methyl and/or n-propyl p-hydroxy-benzoate; one or more coloring agents; one or more flavoring agents; and one or more sweetening agents such as sucrose or saccharin.

The pharmaceutical compositions may also be in the form of oil-in water emulsions. The oily phase may be a vegetable oil, such as olive oil or arachis oil, a mineral oil, such as liquid paraffin, or a mixture of these. Suitable emulsifying agents include naturally-occurring gums, such as gum acacia and gum tragacanth; naturally occurring phosphatides, such as soybean lecithin, esters or partial esters derived from fatty acids; hexitol anhydrides, such as sorbitan monooleate; and condensation products of these partial esters with ethylene oxide, such as polyoxyethylene sorbitan monooleate. The emulsion may also contain sweetening and flavoring agents. Syrups and elixirs may be formulated with sweetening agents, such as glycerol, sorbitol or sucrose. Such formulations may also contain a demulcent, a preservative, a flavoring or a coloring agent.

Additionally, the pharmaceutical compositions may be in the form of a sterile injectable preparation, such as a sterile injectable aqueous emulsion or oleaginous suspension. This emulsion or suspension may be formulated according to the known art using those suitable dispersing or wetting agents and suspending agents which have been mentioned above. The sterile injectable preparation may also be a sterile injectable solution or suspension in a non-toxic parenterally acceptable diluent or solvent, such as a solution in 1,2-propanediol (propylene glycol).

The sterile injectable preparation may also be prepared as a lyophilized powder. Among the acceptable vehicles and solvents that may be employed are water, Ringer's solution, and isotonic sodium chloride solution. In addition, sterile fixed oils may be employed as a solvent or suspending medium. For this purpose any bland fixed oil may be employed including synthetic mono- or diglycerides. In addition, fatty acids such as oleic acid may likewise be used in the preparation of injectables.

To obtain a stable water-soluble dose form of a pharmaceutical composition, a pharmaceutically acceptable salt of a compound described herein may be dissolved in an aqueous solution of an organic or inorganic acid, such as 0.3 M solution of succinic acid, or more preferably, citric acid. If a soluble salt form is not available, the compound may be dissolved in a suitable co-solvent or combination of co-solvents. Examples of suitable co-solvents include alcohol, propylene glycol, polyethylene glycol 300, polysorbate 80, glycerin and the like in concentrations ranging from about 0 to about 60% of the total volume. In applications where DMSO is not prohibited, the active may first be dissolved in DMSO and then diluted with water.

The pharmaceutical composition may also be in the form of a solution of a salt form of the active ingredient in an appropriate aqueous vehicle, such as water or isotonic saline or dextrose solution. Also contemplated are compounds which have been modified by substitutions or additions of chemical or biochemical moieties which make them more suitable for delivery (e.g., increase solubility, bioactivity, palatability, decrease adverse reactions, etc.), for example by esterification, glycosylation, PEGylation, etc.

In one embodiment, the compounds described herein may be formulated for oral administration in a lipid-based formulation suitable for low solubility compounds. Lipid-based formulations can generally enhance the oral bioavailability of such compounds.

As such, a pharmaceutical composition comprises a therapeutically or prophylactically effective amount of a compound described herein, together with at least one pharmaceutically acceptable excipient selected from the group consisting of-medium chain fatty acids or propylene glycol esters thereof (e.g., propylene glycol esters of edible fatty acids such as caprylic and capric fatty acids) and pharmaceutically acceptable surfactants such as Polyoxyl 40 hydrogenated castor oil.

In an alternative preferred embodiment, cyclodextrins may be added as aqueous solubility enhancers. Preferred cyclodextrins include hydroxypropyl, hydroxyethyl, glucosyl, maltosyl and maltotriosyl derivatives of α-, β-, and γ-cyclodextrin. A particularly preferred cyclodextrin solubility enhancer is hydroxypropyl-o-cyclodextrin (BPBC), which may be added to any of the above-described compositions to further improve the aqueous solubility characteristics of the compounds of the embodiments. In one embodiment, the composition comprises about 0.1% to about 20% hydroxypropyl-o-cyclodextrin, more preferably about 1% to about 15% hydroxypropyl-o-cyclodextrin, and even more preferably from about 2.5% to about 10% hydroxypropyl-o-cyclodextrin. The amount of solubility enhancer employed will depend on the amount of the compound of the embodiments in the composition.

In some exemplary embodiments, a CSA comprises a multimer (e.g., a dimer, trimer, tetramer, or higher order polymer). In some exemplary embodiments, the CSAs can be incorporated into pharmaceutical compositions or formulations. Such pharmaceutical compositions/formulations are useful for administration to a subject, in vivo or ex vivo. Pharmaceutical compositions and formulations include carriers or excipients for administration to a subject.

Such formulations include solvents (aqueous or non-aqueous), solutions (aqueous or non-aqueous), emulsions (e.g., oil-in-water or water-in-oil), suspensions, syrups, elixirs, dispersion and suspension media, coatings, isotonic and absorption promoting or delaying agents, compatible with pharmaceutical administration or in vivo contact or delivery. Aqueous and non-aqueous solvents, solutions and suspensions may include suspending agents and thickening agents. Such pharmaceutically acceptable carriers include tablets (coated or uncoated), capsules (hard or soft), microbeads, powder, granules and crystals. Supplementary active compounds (e.g., preservatives, antibacterial, antiviral and antifungal agents) can also be incorporated into the compositions.

Cosolvents and adjuvants may be added to the formulation. Non-limiting examples of cosolvents contain hydroxyl groups or other polar groups, for example, alcohols, such as isopropyl alcohol; glycols, such as propylene glycol, polyethyleneglycol, polypropylene glycol, glycol ether; glycerol; polyoxyethylene alcohols and polyoxyethylene fatty acid esters. Adjuvants include, for example, surfactants such as, soya lecithin and oleic acid; sorbitan esters such as sorbitan trioleate; and polyvinylpyrrolidone.

A pharmaceutical composition contains a total amount of the active ingredient(s) sufficient to achieve an intended therapeutic effect.

The composition including a CSA may be administered with other active agents. For example, in an embodiment, it may be administered with an antibiotic and/or antifungal agent. In an embodiment, the composition may be administered with an agent such as BACTIVATE, which serves to activate dormant bacteria, causing the bacteria to quickly start dividing and multiplying, rendering the bacteria more easily treatable with antibiotics and/or CSAs. BACTIVATE is available from University of Copenhagen professor Anders Miki Bojesen and embryologist Morten Rønn Petersen.

II. METHODS FOR ENHANCING FERTILITY IN A MAMMAL

Infectious causes of infertility (e.g., metritis, endometritis, or uterine infection) may be the most common cause of infertility in a mammal, such as a mare. Such conditions often result in inflammation or infection of the inner lining of the uterus, and are mostly commonly caused by bacteria, although fungal infection also may occur. Endometritis affects up to 15% of broodmares. Endometritis is often invisible, undetectable, and often under-diagnosed. The use of CSAs provides a very broad spectrum non-toxic treatment that can be routinely used by veterinarians or other medical practitioners, does not lead to resistance as do antibiotics, and is very economical. CSAs penetrate the epithelial tissue better than antibiotics, which results in a lower incidence of recurrence than with treatments with antibiotics only. In addition, repeated use of antibiotics often leads to yeast and fungal infections, which is not an issue with use of CSAs.

CSA compositions have been shown to be effective in the breakup of biofilm, and can even be used as a preventative treatment in sub-clinical endometritis, where clinical signs are not apparent. Use of a CSA lavage composition and/or infusion of a CSA composition provide excellent treatment where uterine lavage may be recommended. In case of compostions formulated for lavage, the compositions may include from about 50 mg to about 200 mg of one or more CSA compounds in a suitable carrier, such as saline solution, lactated ringer's solution, or sterile water. Sometimes propylene glycol (e.g., 1%) can be added. For infusion, about 20 mg to about 100 mg of one or more CSA compounds can be administered using any suitable carrier or delivery method. The infusion may be typically used where an antibiotic infusion would be employed.

In addition to providing surprisingly improved results (e.g., allowing mares that could not successfully conceive and foal even with antibiotic treatment to do so), the presently described compositions and methods provide for improved retention of the CSAs in the uterus as compared to existing alternatives. Of course, the CSA compositions and methods may be employed in conjunction with antibiotics, antifungals, etc., with the added advantage that the use of one or more CSA compounds reduces the required or recommended amount of conventional antibiotics used for effective treatment.

When fluid remains stagnant in the equine uterus, it is believed to weaken the effect of bacteria fighting white blood cells. It may flatten out the normal fold along the endometrial surface, which is lined with tiny hair-like cilia. When the folds are flattened out, it can become much harder for the leukocytes to attack the bacteria, and the cilia may become far less effective in sweeping contaminants towards the cervix. Bacteria may be retained more easily on damaged areas of the endometrium, especially if the protective mucus blanket has been thinned or eliminated due to persistent inflammation.

The mare's uterus is well-protected physically, with the cervix, vestibular-vaginal sphincter (hymen), and vulva lips all serving as effective barriers against contaminants such as feces, urine, and bacteria. However, these contaminants can enter the uterus during mating or artificial insemination, as well as during estrus or veterinary procedures. To clear contaminants and dead sperm after breeding, the uterus sets off a natural inflammatory response. This acute form of endometritis is a healthy, effective cleaning system that summons white blood cells (leukocytes) to attack and kill bacteria and rid the mare of dead sperm. The debris is expelled from the uterus, which returns to its normal, uninflamed state. In healthy, fertile mares, this process typically takes less than 2 days. Mares with a delayed inflammatory response may not react immediately to the contaminants, however, allowing the contaminants to settle in the uterus, and in the case of bacteria or fungi, to reproduce. The result can be increased inflammation 3-4 days later, with secondary infection. This condition is referred to as chronic or persistent endometritis, which causes infertility.

In treating endometritis, many of the available antibiotics experience resistance buildup, and in some cases, veterinarians use products that are toxic. The CSA compositions do not experience resistance and are not toxic.

According to some embodiments, a method for increasing fertility in a mammal comprises: administering a therapeutically effective amount of at least one cationic steroid antimicrobial (CSA) compound, or a pharmaceutically acceptable salt thereof, to a reproductive structure of a mammal. The reproductive structure can be a vagina, cervix, uterus, and combinations thereof in a female mammal or a penis in a male mammal (e.g., prior to copulation with a female).

The at least one CSA compound or pharmaceutically acceptable salt thereof can be administered to the reproductive structure of the mammal as a CSA-containing lavage and/or infusion composition including a solvent or liquid carrier and the at least one CSA compound or pharmaceutically acceptable salt thereof. Alternatively, the CSA-containing composition can be administered to the reproductive structure of a mammal as an ointment or other topical composition including a liquid or emollient carrier and the at least one CSA or pharmaceutically acceptable salt thereof. In some embodiments, both a CSA lavage (e.g., diluted with a large fraction of diluent) and a CSA infusion (e.g., less dilute, less volume to be administered) may be applied.

The CSA compound or pharmaceutically acceptable salt thereof kills microbes and/or breaks up microbial plaque or biofilm located on or within the reproductive structure. According to some embodiments, the at least one CSA compound or pharmaceutically acceptable salt thereof kills at least 90% of one or more types of microbes. The at least one CSA compound or pharmaceutically acceptable salt thereof may kill one or more types of sperm-killing microbes where administered, while the at least one CSA or pharmaceutically acceptable salt thereof and its concentration are adapted so that any residual CSA or pharmaceutically acceptable salt thereof that may remain on or in a treated reproductive structure following treatment are adapted not to harm one or more types of beneficial microbes typically present within the reproductive structure of the mammal. Where any residual CSA or salt thereof remains on or in the reproductive structure, it may advantageously not pool within the uterus, but be dispersed.

The at least one CSA compound or pharmaceutically acceptable salt thereof can be present in a concentration sufficient to kill both planktonic and biofilm forms of microbes without causing harm to beneficial microbes residing within the reproductive structure of the mammal. The at least one CSA compound or pharmaceutically acceptable salt thereof at least partially breaks up a microbial plaque or film located within a uterus, which can cause of infertility in the mammal.

In some embodiments, the at least one CSA compound is delivered as part of a CSA-containing composition comprising a solvent or liquid carrier, at least one CSA compound, and a micelle-forming agent forming micelles encapsulating at least a portion of CSA molecules of the at least one CSA compound so that no more than 25% of the CSA molecules form agglomerates larger than 1 micron in size.

According to one theory, the CSA-containing composition acts by breaking up biofilms and/or killing microbes that form biofilms present in the uterus or other reproductive structure of a mammal that might inhibit fertilization and/or implantation. Such biofilms may form a barrier between gametes (i.e., sperm cells and the ovum) and/or prevent implantation of a fertilized zygote within the uterus and/or cause spontaneous abortion of a zygote shortly after implantation. It is believed that CSA-containing compositions are able to break up biofilms and/or kill microbes that form such biofilms as a result of the unique amphiphilic nature and chemical functionalities contained in CSA compounds. The CSA-containing composition can hasten uterine epithelial cell healing due to its epitheliotrophic activity and modulates the inflammation due to enhanced innate immune response. Use of CSA-containing compositions as described herein has been found to effectively treat endometritis and inflammation associated therewith, allowing the female to conceive and have a successful pregnancy.

Compositions that include CSA compounds may be formulated to be especially beneficial for enhancing fertility on mammals. In some embodiments, the CSA-containing compositions can be formulated in order to deliver CSA compounds as individually dispersed CSA molecules and/or very small CSA particles having low agglomeration. According to one embodiment, CSA particles are formulated in order to remain stable and resist agglomeration to larger CSA particles over a desired time period. This may be accomplished, for example, by the use of micelle-forming agents that are able to form micelles in a liquid carrier, which encapsulate the CSA molecules and prevent or reduce agglomeration.

III. EXAMPLES Example 1

A study was undertaken to determine the histologic effect that infusion of the present lavages into the uterus for four consecutive days would have on the endometrium, and to determine the pregnancy rates following a single infusion of a CSA-containing lavage 24 hours post breeding.

In part one of the study protocol, the histologic effect of intra-uterine infusion of the composition on the endometrium was evaluated. Part 1 of the protocol was as follows:

-   -   Day 0: culture, cytology, and first biopsy obtained when mare         has a 25 mm follicle, moderately relaxed cervix, and greater         than or equal to 1.5 uterine edema.     -   Day 1: infuse 50 mL of sterile saline and 10 mL of a composition         comprising 20 mg to 100 mg CSA (“Ceragyn CSA”) (e.g., 50 mg         CSA-44).     -   Day 2: lavage with 1 L Lactated Ringer's Solution (LRS),         followed by infusion of 50 mL sterile saline and 10 mL Ceragyn         CSA.     -   Day 3: lavage with 1 L LRS, followed by infusion of 50 mL         sterile saline and 10 mL Ceragyn CSA.     -   Day 4: lavage with 1 L LRS, followed by infusion of 50 mL         sterile saline and 10 mL Ceragyn CSA.     -   Day 5: lavage with 1 L LRS.     -   Day 6: biopsy.     -   Next estrus cycle, culture, cytology, and biopsy obtained when         mare has 25 mm follicle, moderately relaxed cervix and greater         than or equal to 1.5 uterine edema.

The results of part 1 of the protocol showed no significant difference in endometrial biopsy scores prior to and post intra-uterine infusion of Ceragyn CSA. That means that Ceragyn CSA had no measurable negative histologic effect.

Part 2 of the protocol was directed to determining pregnancy rates following a single intra-uterine infusion of Ceragyn CSA post breeding. Part 2 of the protocol was as follows:

-   -   Day 0: 2,500 IU of hCG was administered intravenously when there         was a 35 mm follicle and grade 3 uterine edema.     -   Day 1: inseminate 1 billion sperm (>30% progressive motility).     -   Day 2: infused 60 cc solution containing 10 cc Ceragyn CSA         diluted in 50 cc saline.     -   Day 3: mares were ultrasounded per rectum daily until ovulation         was detected and evaluated for pregnancy 14 days post ovulation.

For the mares that fulfilled these criteria (5 mares, 6 cycles), 4 cycles resulted in pregnancy and 2 cycles did not (66% per cycle conception rate). Of the 2 mares that did not conceive, with 1 mare the experiment was repeated and she became pregnant. The other mare did not become pregnant when subsequently bred without Ceragyn CSA.

Example 2

A study was undertaken to evaluate use of a CSA-containing composition (Ceragyn CSA) in mares. The facility where the study was undertaken specializes in embryo transfers and frozen embryos. The mares treated in this example had previously been at a leading school of veterinary medicine for a period of two years, and during that time, the veterinarians in charge of treatment were unable to extract a viable embryo due to yeast infections and other complications.

When the mares arrived at the facility where Ceragyn CSA was being evaluated, they were first treated with conventional antibiotics. Following conventional treatment with antibiotics, the attending veterinarians were not able to extract any viable embryo from the mares.

After learning about Ceragyn CSA, the attending veterinarians used Ceragyn CSA in the two mares, along with other recipient mares that had struggled to retain a pregnancy. Treatment with Ceragyn CSA included application of a Ceragyn CSA uterine lavage providing about 50 mg to about 200 mg CSA (e.g., 100 mg CSA-44) to flush the uterus up to 4 hours prior to insemination and/or 6 to 48 hours after breeding. Lavage treatment prior to insemination is helpful in treating infertility associated with fluid retained in the uterus. Lavage treatment post-breeding is helpful in treating post breeding endometriosis.

For each lavage treatment, 60 mL of the Ceragyn CSA composition was mixed with 1 L sterile water, saline, or Lactated Ringer's Solution (LRS) and administered using a sterile catheter. Treatment with Ceragyn CSA also included application of a Ceragyn CSA uterine infusion to treat gram-negative and gram-positive infections, as well as yeast infections. For each infusion treatment, 60 mL of the Ceragyn CSA composition was transferred into a sterile syringe and aseptically administered into the uterus using a sterile catheter or pipette. After such treatment, the attending veterinarians were able to successfully complete an embryo transfer.

Example 3

A top quality veterinary medical and surgical services facility had a 16 year old Quarter Horse mare that had been unable to get in foal for two years. Treatment proceeded as follows. Initially, a 1 cm by 3 cm tissue section was submitted from the endometrium of the mare to Antech Diagnostics, in Irvine, Calif. This section of endometrium was described by Antech as containing a diffuse infiltration of mixed inflammatory cells embedded within the stratum compactum and accompanied by diffuse edema. The overlying mucosal epithelium was intact. The mixed inflammatory reaction was composed of lymphocytes, neutrophils, and plasma cells. Rare foci of inflammatory cell exocytosis were also noted. The supporting stratum spongiosum exhibited diffuse edema. No significant glandular nesting, clumping, or periglandular fibrosis were identified.

The microscopic findings from the lab were described as mild to moderate diffuse acute superficial endometriosis, Grade IIA endometrium. The lab also isolated Escherichia coli and Alpha-hemolytic streptococci. The sensitivity panel yielded the results in Table 1.

TABLE 1 Sensitivity Panel Alpha hemolytic Escherichia coli streptococci Antibiotic Organism Isolated organism isolated Amikacin Sensitive Resistant Ampicillin Intermediate Sensitive Cefazolin Sensitive Sensitive Ceftiofur Sensitive Sensitive Enrofloxacin Sensitive Sensitive Erythromycin N/A Sensitive Florfenicol Sensitive N/A Gentamicin Sensitive Resistant Oxytetracycline Resistant Sensitive Rifampin N/A Sensitive Ticarcillin Sensitive Sensitive Trimmicosin Intermediate N/A TMP/Sulfa Resistant Sensitive

Twenty-one (21) days later, when the mare was coming back in heat, the mare was lavaged with 2 mL Amikacin and 60 mL of Ceragyn CSA uterine lavage combined in a liter of normal saline. On the next day, the uterus had pooled fluid of approximately 250 mL. The prior lavage treatment was repeated along with 40 IU oxytocin immediately after lavage and repeated in 4 hour intervals for 3 successive treatments. At the time of the lavage, the mare was given 1 mL Deslorelin. One day later, the mare had no fluid in uterus and was taken to be bred live cover. The owner confirmed that the mare foaled approximately 11 months later. In the attending veterinarian's opinion, the Ceragyn CSA treatment made the difference as other treatments had developed resistance.

The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope. 

What is claimed is:
 1. A method for increasing fertility in a mammal, comprising: administering a therapeutically effective amount of at least one cationic steroid antimicrobial (CSA) compound, or a pharmaceutically acceptable salt thereof, to a reproductive structure of a mammal.
 2. A method as in claim 1, wherein the reproductive structure of the mammal is selected from the group consisting of a vagina, cervix, uterus, and combinations thereof of a female mammal.
 3. A method as in claim 1, wherein the at least one CSA compound or pharmaceutically acceptable salt thereof is administered to the reproductive structure of the mammal as a lavage and/or infusion composition including a solvent or liquid carrier and the at least one CSA compound or pharmaceutically acceptable salt thereof.
 4. A method as in claim 1, wherein the reproductive structure of the mammal is a penis of a male mammal.
 5. A method as in claim 1, wherein the at least one CSA compound or pharmaceutically acceptable salt thereof is administered to the reproductive structure of the mammal as an ointment or other topical composition including a liquid or emollient carrier and the at least one CSA compound or pharmaceutically acceptable salt thereof.
 6. A method as in claim 1, wherein the administered at least one CSA compound or pharmaceutically acceptable salt thereof kills microbes at least partially breaks up microbial plaque or biofilm located on or within the reproductive structure of a female mammal.
 7. A method as in claim 1, wherein the administered at least one CSA compound or pharmaceutically acceptable salt thereof kills microbes that interfere with sperm activity.
 8. A method as in claim 1, wherein the at least one CSA compound or pharmaceutically acceptable salt thereof kills at least 90% of one or more types of microbes.
 9. A method as in claim 1, wherein infertility is caused by metritis or endometritis and wherein the at least one CSA compound or pharmaceutically acceptable salt thereof hastens uterine epithelial cell healing and modulates inflammation.
 10. A method as in claim 1, wherein the at least one CSA compound or pharmaceutically acceptable salt thereof is adapted to and present in a concentration sufficient to kill both planktonic and biofilm forms of sperm killing microbes without causing harm to beneficial microbes residing within the reproductive structure of the mammal.
 11. A method as in claim 1, wherein the mammal is a non-human mammal.
 12. A method as in claim 11, wherein the non-human mammal is a horse, bovine, pig, dog, or cat.
 13. A method as in claim 1, wherein the mammal is a human.
 14. A method as in claim 1, wherein the cationic groups are attached to the steroidal group through hydrolysable ester linkages.
 15. A method as in claim 1, wherein the at least one CSA compound or pharmaceutically acceptable salt thereof is administered using a CSA-containing composition comprising: a solvent or liquid carrier; the at least one CSA compound or pharmaceutically acceptable salt thereof; and a micelle-forming agent forming micelles encapsulating at least a portion of CSA molecules of the at least one CSA compound or pharmaceutically acceptable salt thereof so that no more than 25% of the CSA molecules form agglomerates larger than 1 micron in size.
 16. A method as in claim 1, wherein the at least one CSA compound is a compound of Formula (I) or a pharmaceutically acceptable salt thereof:

where, rings A, B, C, and D are independently saturated, or are fully or partially unsaturated, provided that at least two of rings A, B, C, and D are saturated; m, n, p, and q are independently 0 or 1; R₁ through R₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, and R₁₈ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted alkyl, a substituted or unsubstituted hydroxyalkyl, a substituted or unsubstituted alkyloxyalkyl, a substituted or unsubstituted alkylcarboxyalkyl, a substituted or unsubstituted alkylaminoalkyl, a substituted or unsubstituted alkylaminoalkylamino, a substituted or unsubstituted alkylaminoalkylamino-alkylamino, a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted arylaminoalkyl, a substituted or unsubstituted haloalkyl, a substituted or unsubstituted alkenyl, a substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted aminoalkyloxyalkyl, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted aminoalkylaminocarbonyl, a substituted or unsubstituted aminoalkylcarboxamido, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, a substituted or unsubstituted azidoalkyloxy, a substituted or unsubstituted cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted guanidinoalkyloxy, a substituted or unsubstituted quaternary ammonium alkylcarboxy, and a substituted or unsubstituted guanidinoalkyl carboxy, where Q₅ is a side chain of an amino acid and P.G. is an amino protecting group; and R₅, R₈, R₉, R₁₀, R₁₃, R₁₄ and R₁₇ are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R₅, R₈, R₉, R₁₀, R₁₃, and R₁₄ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted alkyl, a substituted or unsubstituted hydroxyalkyl, a substituted or unsubstituted alkyloxyalkyl, a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted haloalkyl, a substituted or unsubstituted alkenyl, a substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted aminoalkylaminocarbonyl, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, azidoalkyloxy, cyano-alkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, guanidinoalkyloxy, and guanidine-alkylcarboxy, where Q₅ is a side chain of an amino acid and P.G. is an amino protecting group, provided that at least two or three of R₁₋₄, R₆, R₇, R₁₁, R₁₂, R₁₅, R₁₆, R₁₇, and R₁₈ are independently selected from the group consisting of a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted alkylcarboxyalkyl, a substituted or unsubstituted alkylaminoalkylamino, a substituted or unsubstituted alkylaminoalkylamino-alkylamino, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted arylaminoalkyl, a substituted or unsubstituted aminoalkyloxy-aminoalkylaminocarbonyl, a substituted or unsubstituted aminoalkylamino-carbonyl, a substituted or unsubstituted aminoalkylcarboxyamido, a quaternaryammoniumalkylcarboxy, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, azidoalkyloxy, cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted guanidinoalkyloxy, and a substituted or unsubstituted guanidinoalkylcarboxy.
 17. A method as in claim 16, wherein: R₁, R₂, R₄, R₅, R₆, R₈, R₁₀, R₁₁, R₁₄, R₁₆, and R₁₇ are each hydrogen; R₉ and R₁₃ are each methyl; and R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkoxycarbonylalkyl; and alkylcarboxyalkyl.
 18. A method as in claim 16, wherein the at least one CSA compound or pharmaceutically acceptable salt thereof is selected from the group consisting of:

and pharmaceutically acceptable salts thereof.
 19. A method as in claim 16, wherein the at least one CSA compound or pharmaceutically acceptable salt thereof comprises:

or or pharmaceutically acceptable salt thereof.
 20. A method as in claim 1, wherein the pharmaceutically acceptable salt is a hydrochloride salt or a tri-hydrochloride salt.
 21. A method for increasing fertility in a mammal, comprising: administering a therapeutically effective amount of at least one cationic steroid antimicrobial (CSA) compound, or a pharmaceutically acceptable salt thereof, to a reproductive structure of a mammal, wherein the at least one CSA compound is a compound of Formula (IA) or a pharmaceutically acceptable salt thereof:

where, rings A, B, C, and D are independently saturated; R₁ through R₄, R₆, R₇, R₁₁, R₁₂, R₁₆, and R₁₈ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted alkyl, a substituted or unsubstituted hydroxyalkyl, a substituted or unsubstituted alkyloxyalkyl, a substituted or unsubstituted alkylcarboxyalkyl, a substituted or unsubstituted alkylaminoalkyl, a substituted or unsubstituted alkylamino-alkylamino, a substituted or unsubstituted alkylaminoalkylamino-alkylamino, a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted arylaminoalkyl, a substituted or unsubstituted haloalkyl, a substituted or unsubstituted alkenyl, a substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted aminoalkyloxyalkyl, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted aminoalkylaminocarbonyl, a substituted or unsubstituted aminoalkylcarboxamido, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, a substituted or unsubstituted azido-alkyloxy, a substituted or unsubstituted cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted guanidinoalkyloxy, a substituted or unsubstituted quaternary ammonium alkylcarboxy, and a substituted or unsubstituted guanidinoalkyl carboxy, where Q₅ is a side chain of an amino acid and P.G. is an amino protecting group; and R₅, R₈, R₉, R₁₀, R₁₃, R₁₄ and R₁₇ are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R₅, R₈, R₉, R₁₀, R₁₃, and R₁₄ are independently selected from the group consisting of hydrogen, hydroxyl, a substituted or unsubstituted alkyl, a substituted or unsubstituted hydroxyalkyl, a substituted or unsubstituted alkyloxyalkyl, a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aryl, a substituted or unsubstituted haloalkyl, a substituted or unsubstituted alkenyl, a substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted aminoalkylaminocarbonyl, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, azidoalkyloxy, cyano-alkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, guanidinoalkyloxy, and guanidine-alkylcarboxy, where Q₅ is a side chain of an amino acid and P.G. is an amino protecting group, provided that at least two or three of R₁₋₄, R₆, R₇, R₁₁, R₁₂, R₁₆, R₁₇, and R₁₈ are independently selected from the group consisting of a substituted or unsubstituted aminoalkyl, a substituted or unsubstituted aminoalkyloxy, a substituted or unsubstituted alkylcarboxyalkyl, a substituted or unsubstituted alkylaminoalkylamino, a substituted or unsubstituted alkylaminoalkylamino-alkylamino, a substituted or unsubstituted aminoalkylcarboxy, a substituted or unsubstituted arylaminoalkyl, a substituted or unsubstituted aminoalkyloxy-aminoalkylaminocarbonyl, a substituted or unsubstituted aminoalkylamino-carbonyl, a substituted or unsubstituted aminoalkylcarboxyamido, a quaternaryammoniumalkylcarboxy, a substituted or unsubstituted di(alkyl)aminoalkyl, H₂N—HC(Q₅)-C(O)—O—, H₂N—HC(Q₅)-C(O)—N(H)—, azidoalkyloxy, cyanoalkyloxy, P.G.-HN—HC(Q₅)-C(O)—O—, a substituted or unsubstituted guanidinoalkyloxy, and a substituted or unsubstituted guanidinoalkylcarboxy.
 22. A method as in claim 21, wherein: R₁, R₂, R₄, R₅, R₆, R₈, R₁₀, R₁₁, R₁₄, R₁₆, and R₁₇ are each hydrogen; R₉ and R₁₃ are each methyl; and R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkoxycarbonylalkyl; and alkylcarboxyalkyl.
 23. A method as in claim 21, wherein: R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of hydrogen, an unsubstituted (C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) hydroxyalkyl, unsubstituted (C₁-C₁₈) alkyloxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylcarboxy-(C₁-C₁₈) alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈)alkyl, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, unsubstituted (C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino-(C₁-C₁₈) alkylamino, an unsubstituted (C₁-C₁₈) aminoalkyl, an unsubstituted arylamino-(C₁-C₁₈) alkyl, an unsubstituted (C₁-C₁₈) aminoalkyloxy, an unsubstituted (C₁-C₁₈) aminoalkyloxy-(C₁-C₁₈) alkyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxy, an unsubstituted (C₁-C₁₈) aminoalkylaminocarbonyl, an unsubstituted (C₁-C₁₈) aminoalkylcarboxamido, an unsubstituted di(C₁-C₁₈ alkyl) amino alkyl, unsubstituted (C₁-C₁₈) guanidinoalkyloxy, unsubstituted (C₁-C₁₈) quaternaryammoniumalkylcarboxy, and unsubstituted (C₁-C₁₈) guanidinoalkyl carboxy; and R₁, R₂, R₄, R₅, R₆, R₈, R₉, R₁₀, R₁₁, R₁₃, R₁₄, R₁₆, and R₁₇ are independently selected from the group consisting of hydrogen and unsubstituted (C₁-C₆) alkyl.
 24. A method as in claim 21, wherein: R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of hydrogen, an unsubstituted (C₁-C₆) alkyl, unsubstituted (C₁-C₆) hydroxyalkyl, unsubstituted (C₁-C₁₆) alkyloxy-(C₁-C₅) alkyl, unsubstituted (C₁-C₁₆) alkylcarboxy-(C₁-C₅) alkyl, unsubstituted (C₁-C₁₆) alkylamino-(C₁-C₅)alkyl, (C₁-C₁₆) alkylamino-(C₁-C₅) alkylamino, unsubstituted (C₁-C₁₆) alkylamino-(C₁-C₁₆) alkylamino-(C₁-C₅) alkylamino, an unsubstituted (C₁-C₁₆) aminoalkyl, an unsubstituted arylamino-(C₁-C₅) alkyl, an unsubstituted (C₁-C₅) aminoalkyloxy, an unsubstituted (C₁-C₁₆) aminoalkyloxy-(C₁-C₅) alkyl, an unsubstituted (C₁-C₅) aminoalkylcarboxy, an unsubstituted (C₁-C₅) aminoalkylaminocarbonyl, an unsubstituted (C₁-C₅) aminoalkylcarboxamido, an unsubstituted di(C₁-C₅ alkyl)amino-(C₁-C₅) alkyl, unsubstituted (C₁-C₅) guanidinoalkyloxy, unsubstituted (C₁-C₁₆) quaternaryammoniumalkylcarboxy, and unsubstituted (C₁-C₁₆) guanidinoalkylcarboxy; R₁, R₂, R₄, R₅, R₆, R₈, R₁₀, R₁₁, R₁₄, R₁₆, and R₁₇ are each hydrogen; R₉ and R₁₃ are each methyl; and R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkoxycarbonylalkyl; and alkylcarboxyalkyl.
 25. A method as in claim 21, wherein R₃, R₇, and R₁₂ are the same and are selected from the group consisting of aminoalkyloxy and aminoalkylcarboxy; and R₁₈ is selected from the group consisting of alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonyloxyalkyl; di(alkyl) aminoalkyl; C-carboxyalkyl; alkylaminoalkyl; alkyoxycarbonylalkyl; and alkylcarboxyalkyl.
 26. A method as in claim 21, wherein R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of amino-C₃-alkyloxy; amino-C₃-alkyl-carboxy; C₈-alkylamino-C₅-alkyl; C₈-alkoxy-carbonyl-C₄-alkyl; C₁₀-alkoxy-carbonyl-C₄-alkyl; C₈-alkyl-carbonyl-C₄-alkyl; di-(C₅-alkyl)amino-C₅-alkyl; C₁₃-alkylamino-C₅-alkyl; C₆-alkoxy-carbonyl-C₄-alkyl; C₆-alkyl-carboxy-C₄-alkyl; and C₁₆-alkylamino-C₅-alkyl.
 27. A method for increasing fertility in a mammal, comprising: administering a therapeutically effective amount of a cationic steroid antimicrobial (CSA)-containing composition to a reproductive structure of a mammal, the CSA-containing composition comprising: a solvent or liquid carrier; at least one CSA compound of Formula (TB) or a pharmaceutically acceptable salt thereof:

wherein R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkoxycarbonylalkyl; and alkylcarboxyalkyl; and a micelle-forming agent forming micelles encapsulating at least a portion of CSA molecules of the at least one CSA compound so that no more than 25% of the CSA molecules form agglomerates larger than 1 micron in size.
 28. A method as in claim 27, wherein R₃, R₇, R₁₂, and R₁₈ are independently selected from the group consisting of amino-C₃-alkyloxy; amino-C₃-alkyl-carboxy; C₈-alkylamino-C₅-alkyl; C₈-alkoxy-carbonyl-C₄-alkyl; C₁₀-alkoxy-carbonyl-C₄-alkyl; C₈-alkyl-carbonyl-C₄-alkyl; di-(C₅-alkyl)amino-C₅-alkyl; C₁₃-alkylamino-C₅-alkyl; C₆-alkoxy-carbonyl-C₄-alkyl; C₆-alkyl-carboxy-C₄-alkyl; and C₁₆-alkylamino-C₅-alkyl. 